Abstract 234: Increased Likelihood Of Survival For Patients Presenting With Non-shockable Cardiac Arrest And Treated With A Device-assisted Head-up CPR Bundle

Abstract

Introduction: Despite receiving conventional (C) CPR and other standard treatments, almost all out-of-hospital cardiac arrest (OHCA) patients with non-shockable presentations will still die. As non-shockable presentations comprise nearly 80% of all OHCA cases, alternative treatment strategies are clearly indicated. Hypothesis: Compared to C-CPR controls, treatment with AHUP CPR (defined as the combination of an automated head up positioning [AHUP] device, an impedance threshold device [ITD], and manual and/or automated suction cup-based CPR), increases the probability of survival (SURV) to hospital discharge as well as neurologically favorable survival (N-SURV) for OHCA patients with (first recorded) non-shockable presentations. Methods: Prospectively collected data were obtained from a national AHUP CPR registry from 5 early adopting first responder EMS agencies that routinely initiated immediate AHUP CPR and tracked OHCA outcomes. Comparisons were made to C-CPR controls using individual patient data from high-performing prehospital systems participating in the NIH-funded Resuscitation Outcomes Consortium ROC-PRIMED and ResQTrial studies. AHUP and C-CPR patients presenting with a non-shockable rhythm were matched for the same discrete time interval from the 9-1-1 call to EMS CPR start time and propensity score for the key baseline covariables associated with outcome (e.g., age, sex, bystander-witnessed, bystander CPR) with a 1:1 ratio. Neuro-intact survival was defined as a modified Rankin Scale < 3 or Cerebral Performance Category 1 or 2. Results: AHUP CPR treatment in non-shockable rhythm cases (n=380) was associated with increased unadjusted SURV rates of 7.4% vs 3.1% for C-CPR controls (1,852): Odds ratios (OR) and 95% confidence intervals [CI] = 2.46 [1.33-3.92]. After propensity matching, AHUP CPR was associated with increased SURV and N-SURV vs C-CPR controls: OR[CI] were 2.84[1.35-5.96] and 3.87[1.27-11.78], respectively. Also, the faster AHUP was initiated, the greater the benefit. Conclusions: This analysis provides strong clinical evidence of higher likelihood of survival, including favorable neurological function, for the vast majority of OHCA patients who present with a non-shockable rhythm by using AHUP CPR.